Understanding Hashimoto's Encephalopathy 2016 Edition:
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Tests and diagnosis


By definition, for diagnosis HE/SREAT patients must show elevated thyroid antibodies – including anti-thyroid peroxidase antibodies (anti-TPO), anti-thyroid microsomal antibodies (anti-M), and/or antithyroglobulin antibodies (anti-Tg).  Notably, however, studies show that the titre (concentration) of elevated antibodies does not necessarily correlate with the severity of symptoms. The presence of elevated thyroid antibody levels is considered to be merely a marker associated with the disorder, not the cause of symptoms. Although testing for elevated antibodies is usually based on serum, these elevated antibody levels are sometimes also present in cerebral spinal fluid (CSF) as well.

HESA  interviewed neurologist Dr. Elzbieta Wirkowski and asked, “What criteria do you use to
recognize HE in clinical practice?

Dr. Wirkowski:
I have seen a wide variety of clinical presentations in HE, and now routinely screen both my hospital and clinic patients for antithyroid antibodies. The profile that would trigger me to consider a course of immunotherapy would be a patient with a relatively normal thyroid function test, highly elevated thyroid antibody levels, and unexplained neurological or psychiatric symptoms. A positive response to immunotherapy would further support the diagnosis.


Recently, a number of scientists have studied serum autoantibodies against the NH2-terminal of a-enolase (NAE), which seem to hold promise as a specific diagnostic marker for HE, though this research is limited.

Learn more here:




The electroencephalogram studies of HE/SREAT patients are usually abnormal (up to 90% of cases), but they are usually non-diagnostic findings. The most common findings are diffuse or generalized slowing, or frontal intermittent rhythmic delta activity (FIRDA). Prominent triphasic waves, focal slowing, epileptiform abnormalities, photoparoxysmal and photomyogenic responses are occasionally seen.


Magnetic resonance imaging (MRI) and computed tomography (CT) scans are frequently normal in those with HE/SREAT. Single-photon emission computed tomography (SPECT) scans often disclose hypoperfusion, and positron emission tomography (PET) scans often disclose hypometabolism.


Last edited by Web Team on June 20th, 2016

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AE Alliance
"The Autoimmune Encephalitis Alliance promotes collaboration to improve care, find a cure and create community so that no one faces autoimmune encephalitis alone.

The Encephalitis Society
"The Encephalitis Society is an International organization providing information and support for all causes of Encephalitis."

Encephalitis Global
"Encephalitis Global is a U.S.A. 501(c)(3) non-profit organization formed in 2005 as an alliance connecting encephalitis survivors and caregivers around the world."

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Madison's Foundation Provides information about rare diseases and connects parents whose children have the same rare disease.

NIH Health Hotline
Toll-free numbers from the National Library of Medicine's Health Hotlines Database.

HE Notebook - Wordpress Site
A great blog of an HE patient with a trove of information, personal stories, and links to medical studies.